Multidetector CT imaging of post-robot-assisted laparoscopic radical prostatectomy complications

BACKGROUND: Robot-assisted laparoscopic radical prostatectomy (RALRP) is currently accepted as the preferred minimally invasive surgical treatment for localised prostate cancer, with optimal oncologic and functional results. Despite growing surgical experience, reduced postoperative morbidity and hospital stays, RALRP-related complications may occur, which are severe in 5–7 % of patients and sometimes require reoperation. Therefore, in hospitals with an active urologic surgery, urgent diagnostic imaging is increasingly requested to assess suspected early complications following RALRP surgery. METHODS: Based upon our experience, this pictorial review discusses basic principles of the surgical technique, the optimal multidetector CT (MDCT) techniques to be used in the postoperative urologic setting, the normal postoperative anatomy and imaging appearances. RESULTS: Afterwards, we review and illustrate the varied spectrum of RALRP-related complications including haemorrhage, urinary leaks, anorectal injuries, peritoneal changes, surgical site infections, abscess collections and lymphoceles, venous thrombosis and port site hernias. CONCLUSION: Knowledge of surgical procedure details, appropriate MDCT acquisition techniques, and familiarity with normal postoperative imaging appearances and possible complications are needed to correctly perform and interpret early post-surgical imaging studies, particularly to identify those occurrences that require prolonged in-hospital treatment or surgical reintervention. TEACHING POINTS: • Robot-assisted laparoscopic radical prostatectomy allows minimally invasive surgery of localised cancer • Urologic surgeons may request urgent imaging to assess suspected postoperative complications • Main complications include haemorrhage, urine leaks, anorectal injuries, infections and lymphoceles • Correct multidetector CT techniques allow identifying haematomas, active bleeding and extravasated urine • Imaging postoperative complications is crucial to assess the need for surgical reoperation